Individual
BENJAMIN PARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
986 BRIDGE ST, LAFAYETTE, OR 97127-9174
(503) 381-3925
Mailing address
986 BRIDGE ST, LAFAYETTE, OR 97127-9174
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
22955
OR
Other
Enumeration date
12/30/2016
Last updated
12/30/2016
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